54934-V 1421 Saratoga-Sunnyvale
Tract No. Lot.No.
CITY OF SAN JOSE BUILDING DEPARTMENT
APPLICATION FOR BUILDING PERMIT
Dated 197 Permit No.
Application is hereby made for a permit to Ili /d
/ y, Typ S B ildin Use Zone e
5 4 Ye'ra +g Occupancy
to be occupied only as d) VP ,ry 4NS T Parking Space_
in accordance with Plans, Specifications and oPlot pJ��Ved h��%vn kler
Estimated Value of Improvements, $ .� °//��jj'
I certify that in the performance of the work for which this permit is issued I shell not employ any parson
in any manner so as to viol a the workme"' ccoompenation laws of C fornie. ' n
Owners Address &� 04Z L(/G
By (Address a 13 L 9 f�r ��rs
RECORD OF INSPECTION
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